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Decreased Clinical Toxicity and Two-Phase Elimination Kinetics Observed After Intravenous Iron Sucrose Overdose

Published:September 09, 2022DOI:https://doi.org/10.1016/j.jemermed.2022.09.005

      Abstract

      Background

      Management of oral iron overdoses is well-established, but there is limited literature regarding intravenous iron sucrose overdoses. Indications for administering deferoxamine after oral iron overdoses include clinical signs and symptoms of toxicity, along with a serum iron concentration ≥ 500 μg/dL. Reported signs and symptoms of iron sucrose overdose do not appear to correlate with those of oral iron overdoses.

      Case Report

      We present a case of intravenous iron sucrose overdose in a clinically well-appearing patient with a presenting serum iron concentration that was several times higher than the usual threshold concentration for initiating deferoxamine treatment. A 21-year-old woman presented to the emergency department after an accidental intravenous iron sucrose overdose. The patient received a home infusion of 1000 mg iron sucrose, which was five times the prescribed dose. Her presenting serum iron concentration was 1799 μg/dL, with bicarbonate and anion gap both within normal limits and an unremarkable physical examination. Because she did not have evidence of severe iron toxicity, she was treated supportively and deferoxamine was not administered. Her serum iron concentration decreased below the toxic range over the next 14 h, and she was discharged home the next day.

      Why Should an Emergency Physician Be Aware of This?

      This patient was managed successfully with expectant care alone, suggesting that iron sucrose overdose has much lower toxicity than oral iron salt overdose. This discrepancy between measured iron concentrations and clinical presentation may be explained by the elimination kinetics of iron sucrose having separate redistribution and elimination phases.

      Keywords

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      References

        • Bryant SM
        • Leikin JB
        • et al.
        Iron.
        in: Brent J Burkhart K Dargan P Critical Care Toxicology: Diagnosis and Management of the Critically Poisoned Patient. Springer International Publishing, 2017: 1313-1324
        • Cantrell FL
        • et al.
        Deferoxamine.
        in: Brent J Burkhart K Dargan P Critical Care Toxicology: Diagnosis and Management of the Critically Poisoned Patient. Springer International Publishing, 2017: 2771-2777
      1. Venofer® Full Prescribing Information. US Food and Drug Administration; 2011.

        • Biary R
        • Li L
        • Hoffman RS.
        Intravenous iron overdose: treat the patient not the number.
        Toxicol Commun. 2019; 3: 37-39
        • Trebach J
        • Biary R
        • Hoffman R
        • Lee D
        • Soghoian S.
        North American Congress of Clinical Toxicology (NACCT) Abstracts 2021: 105. Intravenous Iron Ironically Benign.
        Clin Toxicol. 2021; 59: 1088
        • Biary R
        • Li L
        • Hoffman RS.
        European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) Abstracts 2018: 266. Intravenous iron overdose: treat the patient not the number.
        Clin Toxicol. 2018; 56: 572
        • Danielson BG
        • Salmonson T
        • Derendorf H
        • Geisser P.
        Pharmacokinetics of iron (III)-hydroxide sucrose complex after a single intravenous dose in healthy volunteers.
        Analyt Methods. 1996; 3: M9th0dS
        • Food US
        • Administration Drug
        Guidance for Industry Safety Considerations for Container Labels and Carton Labeling Design to Minimize Medication Errors.
        Center for Drug Evaluation and Research, 2013
        • Louzada ML
        • Hsia CC
        • Al-Ani F
        • et al.
        Randomized double-blind safety comparison of intravenous iron dextran versus iron sucrose in an adult non-hemodialysis outpatient population: a feasibility study.
        BMC Hematol. 2016; 16: 1-8
        • Barot BS
        • Parejiya PB
        • Mehta DM
        • Shelat PK
        • Shah GB.
        Physicochemical and structural characterization of iron–sucrose formulations: a comparative study.
        Pharm Dev Technol. 2014; 19: 513-520
        • Naik M
        • Bhat T
        • Jalalie U
        • Bhat A
        • Waseem M
        • Ganayie MT.
        Efficacy and safety of high dose accelerated intravenous iron sucrose in patients of iron deficiency anemia.
        Int J Res Med Sci. 2017; 5: 3359